School Children In Rural Areas Research Articles

Relationship Between Break-Time Physical Activity, Age, and Sex in a Rural Primary Schools, Wales, UK.

The aim of this study was to examine the physical activity during the break-times of primary school children in rural areas, and its relationship with age and sex. 380 children (192 boys and 188 girls; age=9.5±1.1 years) participated in the study. Break-time physical activity in the morning and lunch breaks was measured by accelerometry. An ANOVA was used to determine differences by sex in each age group, together with the respective confidence intervals and effect sizes. The results showed that 8-year-olds performed more physical exercise than 11-year-olds during the two breaks (p=0.005). For the boys, the 8-year-olds did more physical activity than the 10-year-olds, while, for the girls, those aged 8 and 9 years did more PA than girls aged 11 years (p<0.001). The only difference between boys and girls was for the 10-year-olds (p=0.043), with the boys doing more physical activity. Teachers might find it useful to take these findings into account to design physical activity programmes aimed at increasing the playground physical activity of older children.

Malnutrition and inequalities in Francoist Spain: the impact of a milk supplement on the growth of Spanish schoolchildren (1954-1978)

The Spanish nutritional and food transition was consolidated over the course of the twentieth century. In the pre-transition stage, a renewed interest emerged in the deficiencies presented by children''s diets, and food and nutritional education was considered the best course of action to correct them. The aim of this study was to analyse the changes over time and regional differences in the nutritional status of Spanish schoolchildren in rural areas in the 1950s and 1970s, using their height as an anthropometric parameter. The results revealed the existence of two categories at the beginning of the 1960s: a first group in which the height of children from the Cantabrian coast, the Levante, Catalonia and the Balea - ric Islands was similar to that of well-nourished children, and a second group from the regions of Andalusia, Extremadura and Galicia, who were not as tall. Between 1954 and 1977, the height of well-nourished children rose, particularly between 1954 and the first half of the 1960s. There was also a significant increase in the height of children attending national schools in rural areas, and the regional differences that had existed at the beginning of the 1960s disappeared. These advances were undoubtedly influenced both by the milk supplement and the food and nutritional education activities carried out within the framework of the Spanish Diet and Nutrition Education programme (EDALNU).

Tobacco Habits among the 8 to 15 Years School Children of Rural Haryana

ABSTRACTAimThe present cross-sectional study was undertaken to determine the prevalence and age at initiation of tobacco use among school children in rural areas of Haryana.Materials and methodsA cluster sample design was used to produce a representative sample of schools from Panchkula and Ambala district. All students were included from the selected schools and information regarding tobacco use was collected from students of class 3 to 10 (8-15 years) through a self-administered questionnaire.ResultsA total of 3526 students with average age of 12.2 ± 2.3 years were screened for tobacco use. About 182 (5.1%) school children were found to be ever users of tobacco and 79 (2.2%) were current tobacco users in any form. Peer pressure was found to be the most common cause of initiating tobacco use by the students.ConclusionPrevalence of tobacco use among the school children of rural Haryana is lower than that reported in urban areas by Global Youth Tobacco Survey (GYTS). However, the downward shift of the age at initiation (&lt;10 years) is a matter of grave concern, which needs to be tackled by creating suitable school environment through health promotion and strengthening anti tobacco laws.How to cite this articleRattan V, Mohanty U, Goyal A. Tobacco Habits among the 8 to 15 Years School Children of Rural Haryana. J Postgrad Med Edu Res 2014;48(4):183-185.

Prevalence of hypertension and variation in blood pressure among school children in rural area of Wardha.

To study the prevalence of hypertension and variation in blood pressure (BP) level among school children in rural India. A cross-sectional study was conducted during the period from April 2010 to March 2012. Participants comprised of 958 school children (in the age group of 6-16 years) from 83 schools covered by three randomly selected primary health centers. After obtaining informed consent from the school principal, a pretested questionnaire was administered and anthropometric measurements were taken. Hypertension was defined as systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) ≥95 th percentile for age, gender, and height measured on three distinct occasions. Overall, prevalence of hypertension and was found to be 29 (3.0%). The proportion of hypertension among males was 13 (2.8%) against 16 (3.2%) in females. Overall mean SBP level was 97.2 mmHg and DBP level was 62.1 mmHg. SBP and DBP found to be correlated with the body mass index, waist circumference, which identifies the need of proper dietary changes at individual and family level. Constructed nomogram for study participants show lesser SBP and DBP values for 90 th and 95 th percentiles among Indian children when compared to NHLBP guidelines. This suggests lesser BP cut-off needed to identify maximum hypertensive population among Indian children.

Dental Fluorosis and its Extended Effects

Fluorosis disease is a serious public health problem, affecting almost 60 million people in 19 states of the 35 states and Union territories in India, in which 6 million or more are children in the age group of 6–14 y [1]. Earlier reports on Fluorosis have been focusing on fluoride (F) entry to the body through drinking F contaminated water, drawn through hand pumps, tube wells and open wells. However, in recent years, information is emerging on F entry to the body through sources other than water viz. (i) food and food products, spiced with black rock salt with 157 ppm F; (ii) use of fluoridated dental products and (iii) industrial emission of F dust and fumes. Discolouration of teeth known as Dental Fluorosis (DF) is the overtly visible sign of excess F ingestion by children. The genesis of DF may commence from intrauterine life when the mother was consuming F in higher quantities during the period of tooth germ eruption i.e., 5–6 mo of gestation. The DF discolouration would be visible in the permanent teeth. There are however, a few reports, on DF in milk teeth. This communication is focusing on the publication appearing in the Indian Journal of Pediatrics on ‘Prevalence of Dental Fluorosis among primary school children in rural areas in Karera block, Madhya Pradesh’ [2]. The problem of DF with an objective to classify DF in primary school children (age 5–12 y) in a few villages in Madhya Pradesh, indicating the percentage of boys and girls afflicted, is reported. Though F levels in water is published elsewhere, for sake of understanding, the lowest and highest F levels in untreated ground water checked by a reliable standard procedure of using Ion Meter is reported. It is also stated that DF examination is done by Dentists. It would have been informative for the target audience if details of DF is provided and described. As such information is missing, a brief description is provided below to provide clarity in the understanding of DF [3].

Prevalence of Dental Fluorosis Among Primary School Children in Rural Areas of Karera Block, Madhya Pradesh

To determine prevalence and severity of dental fluorosis in school going children of ten villages of Karera block of Shivpuri District, Madhya Pradesh. Fluoride ion concentration was measured in ten hand pump and two wells waters with a fluoride meter (ORION model 720). For the study total 750 school children were selected from ten government primary schools of ten rural villages. The survey was conducted during the period of November 2007 through December 2009. The dental and oral examination was done by two trained dentists. The occurrence and severity of dental fluorosis was recorded using Dean's index. Drinking water sources considered for study were hand pumps, and wells. Out of 750 children surveyed, 341 were found affected with dental fluorosis. The boys had greater prevalence (46.75%) as compared to girls (42.18%). Dental fluorosis, as assessed by Dean's Index shows that 20.8% children had grade I, 19.47% grade II, 5.2% grade III. Overall, 45.46% of the sample showed some grades of dental fluorosis. In all the 144 water samples from ten villages fluoride level was higher than permissible limits. The boys had greater prevalence of dental fluorosis over the girls.

Spirulina can increase total-body vitamin A stores of Chinese school-age children as determined by a paired isotope dilution technique.

Spirulina is an alga rich in high-quality protein and carotenoids. It is unclear whether spirulina can improve the total-body vitamin A stores of school-age children in China with a high prevalence of vitamin A malnutrition. We aimed to evaluate the efficacy of spirulina in improving the total-body vitamin A stores of school-age children in rural areas of China when they consumed spirulina in their daily meals. A total of 228 children (6-11 years) were recruited and randomly divided into three groups supplemented with 4g (containing 4·18µg β-carotene), 2g (containing 2·54µg β-carotene) or 0g spirulina 5d/week for 10 weeks, respectively. Before and after the intervention period, each child was given 0·5mg [(2)H4]retinyl acetate and [(2)H8]retinyl acetate, respectively. To assess vitamin A stores, blood samples (3ml) were collected on the third and the twenty-first day after each labelled retinyl acetate dose for a retinol enrichment analysis using a GC mass spectrometer. The concentrations of retinol and β-carotene in serum samples were also determined by using HPLC. After the 10-week intervention, serum β-carotene concentrations of children with 2 or 4g spirulina supplement increased by 0·160 and 0·389µmmol/l, respectively. Total-body vitamin A stores increased significantly, with a median increase of 0·160mmol in children taking 2g spirulina and of 0·279mmol in children taking 4g spirulina. Spirulina is a good dietary source of β-carotene, which may effectively increase the total-body vitamin A stores of Chinese school-age children.

초등학교 저학년 아동의 가족기능과 인터넷 중독

Purpose: This study explored the degree of internet addiction and its influencing factors in lower grade elementary school children in rural areas. Methods: Subjects included 1,137 elementary school children. A structured questionnaire consisting of questions internet addiction, family function and school life satisfaction was used for data collection. Descriptive statistics, <TEX>${\chi}^2$</TEX>-test, ANOVA and Correlation and Regression were performed using a SPSS program. Results: Among the subjects, 85.8% were regular users, 8.1% were potential risk users, and 6.1% were high-risk users. Career of internet use, daily internet access time, the number of conversations per week, the number of times spent eating out and traveling with parents within the last month and activities with friends, and satisfaction on school life differed significantly according to the degree of internet addiction. Finally, among the factors studied, daily internet access time, conversations within family, activities with friends and school life satisfaction in children in early elementary school was 20.7% of the explanatory power of the subjects' degree of internet addiction, collectively. Conclusion: Use of the internet by early elementary school children should be monitored and strategies to promote familial conversations, activities with peers and school life satisfaction should be developed.

Study of blood pressure profile of school children 6–15 years in a rural setting of Maharashtra

BackgroundHigh blood pressure in childhood is a major risk factor for heart disease and stroke in adulthood. There is enough evidence to suggest that the roots of essential hypertension in adults extend into childhood. There is a paucity of literature on the blood pressure measurements amongst children. This study was done to study blood pressure profile of school children in rural area of Maharashtra. Aim & objectivesThis cross sectional study was carried out to determine the prevalence of hypertension in children 6–15 years and to study the association between selected variables and blood pressure. Material & methodsThis study was done using a predesigned questionnaire and making measurements of height, BMI and Blood pressure using standardized physical instruments following standard guidelines. The data was collected and analyzed using appropriate statistical tests. ResultsThe prevalence of hypertension in the study was found to be 4.4% with 3.5% in females and 5.1% in males. ConclusionIn the study, hypertension in students was found to be significantly associated with higher BMI and with family history of hypertension. Age, height and BMI were found to correlate positively with Blood pressure levels in this study.

Prevalencia de sobrepeso y obesidad en escolares de zonas rurales

ObjectivesTo estimate the prevalence of overweight and obesity in schoolchildren in rural areas. MethodsA cross-sectional study was carried out in a sample of 1,513 schoolchildren aged 6, 11 and 14 years. Data were collected on height and weight with digital scales equipped with a measuring rod. We used three criteria to define overweight and obesity: Cole's points, the Centers for Disease Control and Prevention (CDC) criteria and Hernandez's tables. ResultsWhen Cole's points were used, 24.6% (95%CI: 22.5 - 26.8) were overweight and 11.6% (95%CI: 10-13.3) were obese; these percentages were higher in children aged 11 and 6 years, respectively. According CDC growth charts, 19.8% of children (95%CI: 17.9-21.9) were overweight and 16.5% (95%CI: 14.7-18.4) were obese, corresponding to higher percentages at 14 and 6 years. When Hernandez's tables were used, 11.5% (95%CI: 10-13.2) were overweight and 18.6% (95%CI: 16.7-20.6) were obese, and both disorders were higher in children aged 11 years. The risk of obesity and overweight was higher in small rural areas (<5,000 people), with OR = 1.49 (95%CI: 1.13-1.95) and OR = 1.33 (95%CI: 1.06-1.67), respectively. ConclusionsThe prevalence of overweight and obesity in schoolchildren in rural areas is very high and is even higher in towns with less than 5,000 inhabitants.

Prevalence of Intestinal Parasitic Infections among School Children in Rural Area of Vizianagaram

A total of 124 school children of Nellimarla mandal, which includes 65 females and 59 males, were screened for intestinal parasitic infections. E.histolytica and G.intestinalis were the commonest parasites isolated (each 37.7%), followed by H.nana(11.6%), Hookworm(8.7%) and Strongyloides(4.3%).Infection rate was highest in 8 years age group(66.7%). Females (55%) were infected more than males (40%). RESULTS: A total of 65 number of female and 59 number of male children were screened. Out of them intestinal parasitic infection was detected in 55 % of female and 40% of male children. The percentage positivity were 39.5,58.1,66.7 & 43.5 in 6 years, 7 years, 8 years and 9 years age groups respectively. E.histolytica and G.intestinalis were the commonest species isolated (each 37.7%), followed by H.nana (11.6 %), Hook worm(8.7%) and S.stercoralis(4.3%).Highest prevalence (66.7%) was found in 8 years age group and least prevalence (39.5%) was found in 6 years age group. Multiple infections by 3 parasites were found in 4 cases and by 2 parasites were found in 6 cases.

Partnership research on nutrition transition and chronic diseases in West Africa – trends, outcomes and impacts

BackgroundNutrition-related chronic diseases (NRCD) are rising quickly in developing countries, and the nutrition transition is a major contributor. Low-income countries have not been spared. Health issues related to nutritional deficiencies also persist, creating a double burden of malnutrition (DBM). There is still a major shortage of data on NRCD and DBM in Sub-Saharan Africa. A research program has been designed and conducted in partnership with West African institutions since 2003 to determine how the nutrition transition relates to NRCD and the DBM in order to support prevention efforts.MethodsIn Benin, cross-sectional studies among apparently healthy adults (n=540) from urban, semi-urban and rural areas have examined cardiometabolic risk (hypertension, obesity, dyslipidemia, insulin resistance) in relation to diet and lifestyle, also factoring in socio-economic status (SES). Those studies were followed by a longitudinal study on how risk evolves, opening the way for mutual aid groups to develop a prevention strategy within an action research framework. In Burkina Faso, a cross-sectional study on the nutritional status and dietary patterns of urban school-age children (n=650) represented the initial stages of an action research project to prevent DBM in schools. A cross-sectional study among adults (n=330) from the capital of Burkina Faso explored the coexistence, within these individuals, of cardiometabolic risk factors and nutritional deficiencies (anemia, vitamin A deficiency, chronic energy deficiency), as they relate to diet, lifestyle and SES.ResultsThe studies have shown that the prevalence of NRCD is high among the poor, thereby exacerbating social inequalities. The hypothesis of a positive socio-economic (and rural–urban) gradient was confirmed only for obesity, whereas the prevalence of hypertension, insulin resistance and dyslipidemia did not prove to be higher among affluent city dwellers. Women were particularly affected by abdominal obesity, at 48% compared to 6% of men. Protective factors against the risk of NRCD were physical activity and adequate micronutrient intake. The research also showed that nutritional deficiencies were not restricted to schoolchildren in rural areas because in the capital of Ouagadougou, for example, 40% of schoolchildren were anaemic and 40% were vitamin A deficient. Partnership research has expanded to include advocacy and human resources training.ConclusionThese initial studies on NRCD in West Africa indicate the relevance and urgency of prevention, even among low-income groups and countries. They show that the fight against NRCD as well as nutritional deficiencies should focus on women. Seeing how researchers from the African partner institutions have connections with decision-making authorities, the research findings could have an impact on prevention policies and programs in communities and schools alike. Greater support must nevertheless be provided to lobbying and advocacy work for an even greater impact. As well, the sustainability of the research program remains a challenge that requires resource mobilization and training for the purpose.

Prevalence of short stature in Saudi children and adolescents

BACKGROUND AND OBJECTIVE:Data on stature in Saudi children and adolescents are limited. The objective of this report was to establish the national prevalence of short stature in Saudi children and adolescents.DESIGN AND SETTING:Community-based, cross-sectional study conducted over 2 years (2004, 2005)PATIENTS AND METHODS:The national data set of the Saudi reference was used to calculate the stature for age for children and adolescents 5 to 18 years of age. Using the 2007 World Health Organization (WHO) reference, the prevalence of moderate and severe short stature was defined as the proportion of children whose standard deviation score for stature for age was less than -2 and -3, respectively. In addition, the 2000 Center for Disease Control (CDC) and the older 1978 National Center for Health Statistics (NCHS)/WHO references were used for comparison.RESULTS:Using the 2007 WHO reference, sample size in the Saudi reference was 19 372 healthy children and adolescents 5 to 17 years of age, with 50.8% being boys. The overall prevalence of moderate and severe short stature in boys was 11.3% and 1.8%, respectively; and in girls, 10.5% and 1.2%, respectively. The prevalence of moderate short stature was 12.1%, 11% and 11.3% in boys and 10.9%, 11.3% and 10.5% in girls when the 1978 WHO, the 2000 CDC and the 2007 WHO references were used, respectively.CONCLUSIONS:The national prevalence of short stature in Saudi children and adolescents is intermediate compared with the international level. Improvement in the socioeconomic and health status of children and adolescents should lead to a reduction in the prevalence of short stature.

Prevalence and Distribution of Soil Transmitted Helminths (STH) among Asymptomatic School Going Children in South Chennai, Tamil Nadu, India.

International Journal of Medicine and Public Health,2011,1,2,57-59.DOI:10.5530/ijmedph.2.2011.14Published:Apr/2011Type:Short CommunicationPrevalence and Distribution of Soil Transmitted Helminths (STH) among Asymptomatic School Going Children in South Chennai, Tamil Nadu, IndiaN Anbumani, and M Mallika Anbumani. N., Mallika M. Associate Professor, Department of Microbiology, Sri Ramachandra University, Porur, Chennai-600116. Department of Microbiology, Sri Ramachandra University, Porur, Chennai-600116, Tamil nadu, INDIA. Abstract:Soil transmitted helminth (STH ) infections represent a major health problem in poor and developing countries. We conducted a pilot study to determine the prevalence of STH among school going children of Kancheepuram district. Three hundred and fifty eight children in the age group of 5-10 years were examined for STH. One hundred and fourteen of the 358 (40%) were tested positive for various intestinal helminths. The various intestinal helminths are Ascaris lumbricoides, Trichuris trichiura and Taenia species. At least one intestinal helminth was detected in 25.13% (90/358) children and multiple helminth infestation was recorded in 15.08% (54/358). The most common parasitic helminth was A. lumbricoides 60% (84/144) followed by T. trichiura 4.17% (6/144). A. lumbricoides was found as single type infection as well as in association with other helminths in mixed type infection. This study emphasizes the need for improved sanitation and better living conditions for the school-age children in rural areas. Keywords:NillView:PDF (194.46 KB)

Prevalence of dental diseases in 5- to 14-year-old school children in rural areas of the Barabanki district, Uttar Pradesh, India

Epidemiological studies are helpful in planning and implementing oral health programs in a given population. This initiative is a consequence of the absence of any information on any study being conducted in the past on the prevalence of dental diseases in the Barabanki district of Uttar Pradesh (UP). The aims were to (1) assess the prevalence of gingivitis, fluorosis, and malocclusion in the school-going children of rural areas of district Barabanki and (2) evaluate the pattern of above-mentioned diseases in different age groups and genders. A total of 836 school-going children comprising 430 boys and 406 girls were examined. A total of 238 children were in the age group of 5-7 years. A total of 277 and 321 children were in the age groups of 8-10 and 11-14 years, respectively. A chi-square test was used for deriving results. The prevalence of gingivitis, fluorosis, and malocclusion was 78.35%, 33.37%, and 34.09%, respectively. The difference between age groups for the prevalence of gingivitis was highly significant, and was more among girls as compared to boys. A significant increase in the prevalence of malocclusion was observed with age. No significant difference was found among genders for the prevalence of malocclusion. An increase in the prevalence of fluorosis was highly significant with age. The difference in fluorosis was insignificant between boys and girls.

Evaluation on the health education program regarding prevention of non-fatal drowning among school-aged children in Lianping county, Guangdong province

To evaluate the outcome of health education program on drowning prevention among primary and secondary school children in rural areas. A township was selected and all the students from grade 3 to 5, grade 7 to 8, and grade 10 to 11 were selected to take part in the program. Twelve intervention measures on natural water safety and drowning prevention were carried out for one year. Information was collected using the same questionnaire before and after the intervention program. One year after the intervention was carried out, children's knowledge on drowning prevention improved significantly (13.21, 95%CI: 12.51 - 13.90), and a positive effect was also noticed among boys (12.77, 95%CI: 11.77 - 13.77), girls (13.80, 95%CI: 12.82 - 14.78), and among primary school children(15.51, 95%CI: 14.30 - 16.72), senior high school children (10.78, 95%CI: 9.50 - 12.05) and junior high school children (12.77, 95%CI: 11.84 - 13.71). Overall rates on risk behaviors dropped from 41.4% to 32.2% (by 22.2%) including 15.6% for boys, 35.2% for girls and 13.8%, 29.3%, 26.3% for primary school children, senior high school children, junior high school children, respectively. The incidence rates for non-fatal drowning decreased by 58.9% (from 5.6% to 2.3%). The person-times for treatment on sight, in emergency settings, in outpatient clinic or in the hospitals had a reduction from 399, 78, 36 to 175, 32, 14, respectively. Health education program could improve children's perception on water safety, and reduce their risk behaviors as well as on the incidence of non-fatal drowning in the rural areas.

Avaliação de conhecimentos e práticas que adultos e crianças têm acerca da doença de Chagas e seus vetores em região endêmica de Minas Gerais, Brasil

Despite the success of the Chagas Disease Control Program (PCCD) in Brazil, some endemic areas have experienced difficulty in maintaining the program's activities, especially after the health system's decentralization, since the sustainability of control measures for Chagas disease and vectors is known to depend on information and community participation. This study aimed to analyze knowledge and practices related to vectors and Chagas disease in Bambuí, Minas Gerais State, Brasil. The population's knowledge was tested with a questionnaire, accompanied by six illustrations of triatomine bugs for identification. Both adults and primary and secondary schoolchildren in rural areas of the county participated in the research. The Bambuí population showed good overall knowledge on triatomines and Chagas disease in both groups (adults and children), although the concepts were limited to preventing the insect vector from invading houses. The results emphasize the importance of educational campaigns in the context of the program as a fundamental component of community participation in Chagas disease vector control.

Theatre, Life Skills and Participatory Learning

This article describes and evaluates the educational work being undertaken byStudents Partnership Worldwide (SPW) which is an international organisationspecialising in life skills education to school children in rural areas. The articleexamines theatre-related programmes in which the organisation makes use of theatre as an instrument to teach life skills. Special emphasis is focused on “Albatross”, a play which was performed in 2003.

Stunting and zinc deficiency among primary school children in rural areas with low soil zinc concentrations in Jiangsu Province, China.

To assess stunting and zinc deficiency among primary school children in north rural area of Jiangsu Province with low soil zinc concentrations, eastern part of China. Two data collection rounds were conducted. In the first data collection round, 2268 primary school children aged 6-9 years were included by cluster sampling from three counties with low soil zinc concentrations. Anthropometric measures were assessed and stunting was defined as a z-score of height-for-age (HAZ) below -2 according to the WHO new Growth Standards in 2006. For the second data collection round, the county with the highest prevalence of stunting was selected. From this county, 297 children aged 6-9 years were recruited by cluster sampling. Anthropometric measures, serum and hair zinc, and haemoglobin were measured at this stage. The total prevalence of stunting (HAZ < -2) and mild stunting (-2 <or= HAZ< -1) was 4.7% and 22.8% respectively, and Huaian had the highest prevalence of stunting (8.1%) among the three counties. In Huaian County the prevalence of zinc deficiency based on serum zinc concentration, hair zinc concentration, and both was 0.7%, 15.2% and 15.3%, respectively, and 32.3% of subjects were anaemic. Boys had a higher prevalence of zinc deficiency than girls (19.1 vs. 10.5%, p < 0.05), whereas the prevalence of anaemia in boys was lower than that in girls (28.2 vs. 37.3%, p = 0.07). Stunting and zinc deficiency were not highly prevalent among primary school children in rural counties with low soil zinc concentrations of Jiangsu Province.

Dental caries and treatment needs of children (6-10 years) in rural Udaipur, Rajasthan

This study was done to examine caries prevalence and corresponding treatment needs in school children of rural areas of Udaipur, Rajasthan. A total of 750 children of rural areas in the age group of 6-10 years were examined, using WHO index, to record the prevalence of dental caries and treatment needs. The results were subjected to statistical analysis using chi square test. Dental caries was found in 63.20% children, and 85.07% children needed dental treatment. The highest need was of one surface filling (85.73%) followed by sealant (51.20%). Dental caries showed to be a significant health issue in the rural population requiring immediate attention.